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1.
Transpl Int ; 33(5): 544-554, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31984577

RESUMO

The aim of this study was to investigate whether there is an impact of donation rates on the quality of lungs used for transplantation and whether donor lung quality affects post-transplant outcome in the current Lung Allocation Score era. All consecutive adult LTx performed in Eurotransplant (ET) between January 2012 and December 2016 were included (N = 3053). Donors used for LTx in countries with high donation rate were younger (42% vs. 33% ≤45 years, P < 0.0001), were less often smokers (35% vs. 46%, P < 0.0001), had more often clear chest X-rays (82% vs. 72%, P < 0.0001), had better donor oxygenation ratios (20% vs. 26% with PaO2 /FiO2  ≤ 300 mmHg, P < 0.0001), and had better lung donor score values (LDS; 28% vs. 17% with LDS = 6, P < 0.0001) compared with donors used for LTx in countries with low donation rate. Survival rates for the groups LDS = 6 and ≥7 at 5 years were 69.7% and 60.9% (P = 0.007). Lung donor quality significantly impacts on long-term patient survival. Countries with a low donation rate are more oriented to using donor lungs with a lesser quality compared to countries with a high donation rate. Instead of further stretching donor eligibility criteria, the full potential of the donor pool should be realized.


Assuntos
Transplante de Pulmão , Transplantados , Adulto , Humanos , Pulmão , Estudos Prospectivos , Estudos Retrospectivos , Doadores de Tecidos , Resultado do Tratamento
2.
Transpl Int ; 31(8): 930-937, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29665090

RESUMO

Both Eurotransplant (ET) and the US use the lung allocation score (LAS) to allocate donor lungs. In 2015, the US implemented a new algorithm for calculating the score while ET has fine-tuned the original model using business rules. A comparison of both models in a contemporary patient cohort was performed. The rank positions and the correlation between both scores were calculated for all patients on the active waiting list in ET. On February 6th 2017, 581 patients were actively listed on the lung transplant waiting list. The median LAS values were 32.56 and 32.70 in ET and the US, respectively. The overall correlation coefficient between both scores was 0.71. Forty-three per cent of the patients had a < 2 point change in their LAS. US LAS was more than two points lower for 41% and more than two points higher for 16% of the patients. Median ranks and the 90th percentiles for all diagnosis groups did not differ between both scores. Implementing the 2015 US LAS model would not significantly alter the current waiting list in ET.


Assuntos
Transplante de Pulmão , Seleção de Pacientes , Algoritmos , Estudos Transversais , Europa (Continente) , Humanos , Pessoa de Meia-Idade , Estados Unidos
3.
Transpl Int ; 31(11): 1223-1232, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29885002

RESUMO

Internationally 3% of the donor hearts are distributed to re-transplant patients. In Eurotransplant, only patients with a primary graft dysfunction (PGD) within 1 week after heart transplantation (HTX) are indicated for high urgency listing. The aim of this study is to provide evidence for the discussion on whether these patients should still be allocated with priority. All consecutive HTX performed in the period 1981-2015 were included. Multivariate Cox' model was built including: donor and recipient age and gender, ischaemia time, recipient diagnose, urgency status and era. The study population included 18 490 HTX, of these 463 (2.6%) were repeat transplants. The major indications for re-HTX were cardiac allograft vasculopathy (CAV) (50%), PGD (26%) and acute rejection (21%). In a multivariate model, compared with first HTX hazards ratio and 95% confidence interval for repeat HTX were 2.27 (1.83-2.82) for PGD, 2.24 (1.76-2.85) for acute rejection and 1.22 (1.00-1.48) for CAV (P < 0.0001). Outcome after cardiac re-HTX strongly depends on the indication for re-HTX with acceptable outcomes for CAV. In contrast, just 47.5% of all hearts transplanted in patients who were re-transplanted for PGD still functioned at 1-month post-transplant. Alternative options like VA-ECMO should be first offered before opting for acute re-transplantation.


Assuntos
Rejeição de Enxerto/epidemiologia , Cardiopatias/cirurgia , Insuficiência Cardíaca/cirurgia , Transplante de Coração/estatística & dados numéricos , Disfunção Primária do Enxerto/epidemiologia , Reoperação/estatística & dados numéricos , Adulto , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Tempo , Doadores de Tecidos , Adulto Jovem
4.
Transpl Int ; 27(9): 917-25, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24853064

RESUMO

Pediatric heart allocation in Eurotransplant (ET) has evolved over the past decades to better serve patients and improve utilization. Pediatric heart transplants (HT) account for 6% of the annual transplant volume in ET. Death rates on the pediatric heart transplant waiting list have decreased over the years, from 25% in 1997 to 18% in 2011. Within the first year after listing, 32% of all infants (<12 months), 20% of all children aged 1-10 years, and 15% of all children aged 11-15 years died without having received a heart transplant. Survival after transplantation improved over the years, and in almost a decade, the 1-year survival went from 83% to 89%, and the 3-year rates increased from 81% to 85%. Improved medical management of heart failure patients and the availability of mechanical support for children have significantly improved the prospects for children on the heart transplant waiting list.


Assuntos
Transplante de Coração/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Listas de Espera , Adolescente , Determinação da Idade pelo Esqueleto , Criança , Pré-Escolar , Europa (Continente) , Seguimentos , Política de Saúde , Cardiopatias/mortalidade , Cardiopatias/cirurgia , Transplante de Coração/mortalidade , Coração Auxiliar , Humanos , Lactente , Estimativa de Kaplan-Meier , Doadores de Tecidos/provisão & distribuição , Obtenção de Tecidos e Órgãos/organização & administração , Obtenção de Tecidos e Órgãos/normas , Transplantados/classificação , Transplantados/estatística & dados numéricos , Resultado do Tratamento , Listas de Espera/mortalidade
5.
J Heart Lung Transplant ; 42(6): 778-785, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36710093

RESUMO

BACKGROUND: When advanced heart failure occurs in cardiac amyloidosis, prognosis is poor. In this setting heart transplantation (HTX) is a treatment option for selected patients. We here present the results of post-transplantation outcomes in cardiac amyloidosis within the Eurotransplant area, investigating possible predictors of survival. METHODS: Of 115 patients undergoing HTX due to cardiac amyloidosis in the Eurotransplant region between November 1987 and May 2020, detailed assessment prior to transplantation was available in 85 patients. The present study was conducted in a retrospective approach. Primary endpoint was mortality after HTX. Baseline variables were entered in a Cox proportional hazards model with the primary endpoint as a dependent variable. RESULTS: Median overall survival following HTX was 6.3 years in the overall collective and the subgroup. Univariate Cox proportional hazards model revealed a significant relationship between overall survival and the transplantation period (2008 to 2020 vs 1987 to 2007; median survival 9.7 years vs 1.8 years, hazard ratio 0.45, p = 0.01). Further predictors were albumin concentration (hazard ratio 0.92, p < 0.001), and systolic blood pressure (hazard ratio 0.96, p < 0.001). The transplant period as well as albumin concentration remained significant independent predictors in the AL sub cohort in a multivariate Cox proportional hazards model. CONCLUSIONS: HTX is a viable treatment option for patients at an advanced stage of cardiac amyloidosis as overall survival after transplantation has improved in the modern age. Patients at a very advanced stage of the disease, indicated by low serum albumin and blood pressure, show worse outcomes following HTX. Optimal timing and careful patient selection may therefore be particularly important to further improve post-HTX survival in amyloidosis patients.


Assuntos
Amiloidose , Insuficiência Cardíaca , Transplante de Coração , Humanos , Estudos Retrospectivos , Transplante de Coração/efeitos adversos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/cirurgia , Amiloidose/complicações , Amiloidose/cirurgia , Albuminas
7.
Transplantation ; 102(11): 1870-1877, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30130321

RESUMO

BACKGROUND: Both University of Wisconsin (UW) and histidine-tryptophan-ketoglutarate (HTK) solutions are currently used in the Eurotransplant region for preservation of liver allografts. Previous studies on their effect have led to a lot of discussion. This study aims to compare the effect of HTK and UW on graft survival. METHODS: First liver transplantations in recipients 18 years or older from January 1, 2007, until December 31, 2016, were included. Graft survival was compared for livers preserved with HTK and UW at 30 days, 1, 3, and 5 years. Multivariable analysis of risk factors was performed and outcome was adjusted for important confounders. RESULTS: Of all 10 628 first liver transplantations, 8176 (77%) and 2452 (23%) were performed with livers preserved with HTK and UW, respectively. Kaplan-Meier curves showed significant differences in graft survival between HTK and UW at 30 days (89% vs 93%, P=<0.001), 1 year (75% vs 82%, P=<0.001), 3 years (67% vs 72%, P<0.001), and at 5 years (60% vs 67%, P<0.001). No significant differences in outcome were observed in separate analyses of Germany or non-German countries. In multivariable analysis, UW was associated with a decreased risk of graft loss at 30 days (HR 0.772, P=0.002) and at 1 year (0.847 (0.757-0.947). When adjusted for risk factors, no differences in long term outcome could be detected. CONCLUSIONS: Because the use of preservation fluids is clustered geographically, differences in outcome by preservation fluids are strongly affected by regional differences in donor and recipient characteristics. When adjusted for risk factors, no differences in graft survival exist between transplantations performed with livers preserved with either HTK or UW.


Assuntos
Sobrevivência de Enxerto/efeitos dos fármacos , Transplante de Fígado/métodos , Soluções para Preservação de Órgãos/uso terapêutico , Preservação de Órgãos/métodos , Adenosina/efeitos adversos , Adenosina/uso terapêutico , Adulto , Idoso , Alopurinol/efeitos adversos , Alopurinol/uso terapêutico , Europa (Continente) , Feminino , Glucose/efeitos adversos , Glucose/uso terapêutico , Glutationa/efeitos adversos , Glutationa/uso terapêutico , Disparidades em Assistência à Saúde , Humanos , Insulina/efeitos adversos , Insulina/uso terapêutico , Transplante de Fígado/efeitos adversos , Masculino , Manitol/efeitos adversos , Manitol/uso terapêutico , Pessoa de Meia-Idade , Preservação de Órgãos/efeitos adversos , Soluções para Preservação de Órgãos/efeitos adversos , Cloreto de Potássio/efeitos adversos , Cloreto de Potássio/uso terapêutico , Procaína/efeitos adversos , Procaína/uso terapêutico , Rafinose/efeitos adversos , Rafinose/uso terapêutico , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
8.
Transplantation ; 102(8): 1344-1350, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29570164

RESUMO

BACKGROUND: Hypothermic machine perfusion (HMP) of deceased donor kidneys is associated with better outcome when compared to static cold storage (CS). Nevertheless, there is little evidence whether kidneys with short cold ischemia time (CIT) also benefit from HMP and whether HMP can safely extend CIT. METHODS: We analyzed prospectively collected data from the Machine Preservation Trial, an international randomized controlled trial. Seven hundred fifty-two consecutive renal transplants were included: 1 kidney of each of the 376 donors was preserved by HMP, the contralateral organ was preserved by CS. RESULTS: The mean CIT was 3:05 PM (SD, 4:58 AM). A subgroup analysis was performed, groups were based on CIT duration: 0 to 10 hours, 10 to 15 hours, 15 to 20 hours, or 20 hours or longer. Delayed graft function (DGF) incidence in the subgroup with up to 10 hours CIT was 6.0% (N = 3/50) in the HMP arm and 28.1% (N = 18/64) in the CS arm (univariable P = 0.002; multivariable odds ratio [OR], 0.02; P = 0.007). Cold ischemia time remained an independent risk factor for DGF for machine perfused kidneys recovered from donation after brain death donors (OR, 1.06; 95% confidence interval [CI], 1.017-1.117; P = 0.008), donation after circulatory death donors (OR, 1.13; 95% CI, 1.035-1.233; P = 0.006) and expanded criteria donors (OR, 1.14; 95% CI, 1.057-1.236; P = 0.001). CONCLUSIONS: In conclusion, HMP resulted in remarkably lower rates of DGF in renal grafts that were transplanted after a short CIT. Also, CIT remained an independent risk factor for DGF in HMP-preserved kidneys.


Assuntos
Isquemia Fria/métodos , Falência Renal Crônica/cirurgia , Transplante de Rim/métodos , Rim/patologia , Preservação de Órgãos/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Função Retardada do Enxerto/etiologia , Feminino , Sobrevivência de Enxerto , Humanos , Cooperação Internacional , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Soluções para Preservação de Órgãos , Perfusão/métodos , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Tempo , Doadores de Tecidos , Adulto Jovem
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